Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Jaundice is not a disease, but rather a sign that can occur in many different
diseases. Jaundice is the yellowish staining of the skin and sclerae (the whites
of the eyes) that is caused by high levels in blood of a chemical bilirubin.
The color of the skin and the whites of the eyes vary depending on the level of bilirubin. When
the bilirubin level is mildly elevated, they are yellowish. When the bilirubin
level is high, they tend to be brown.
What causes jaundice?
Bilirubin comes from red blood cells. When red blood cells get old, they are
destroyed by the body. Hemoglobin, the iron-containing chemical in
the red blood cells that
carries oxygen, is released from the destroyed red blood cells after the iron it
contains is removed. The chemical that remains in the blood after the iron is
removed becomes bilirubin.
The liver has many functions. One of its functions is to produce and
secrete bile into the intestines to help digest dietary fat. Another function is to
remove toxic chemicals or waste products from the blood, and bilirubin is a
waste product. The liver removes bilirubin from the blood. After the bilirubin
has entered the liver cells, the cells conjugate (attaching other chemicals,
primarily glucuronic acid) to the bilirubin, and then secrete the
bilirubin/glucuronic acid complex into bile. The complex that is secreted in
bile is called conjugated bilirubin. The conjugated bilirubin travels in the
bile to the intestine and is eliminated in
the feces. (Bilirubin is what gives feces its brown color.) Conjugated bilirubin
is different from the bilirubin that is released from the red blood cells
and not yet removed from the blood. The latter is termed unconjugated bilirubin.
Jaundice occurs when there is:
too much bilirubin being produced for the liver
to remove from the blood (for example, patients with
hemolytic anemia have an
abnormally rapid rate of destruction of their red blood cells that releases
large amounts of bilirubin into the blood);
a defect in the liver that
prevents bilirubin from being removed from the blood, converted to
bilirubin/glucuronic acid (conjugated) or secreted in bile; or
the bile ducts that decreases the flow of bile and bilirubin from the liver into
the intestines. For example, the bile ducts can be blocked by
gallstones, or inflammation of the bile ducts. The decreased conjugation,
secretion, or flow of bile that can result in jaundice is referred to as cholestasis: however, cholestasis does not always result in jaundice.
Jaundice, also referred to as icterus, is the yellow staining of the skin and sclerae (the whites of the eyes) by abnormally high blood levels of the bile pigment, bilirubin. The yellowing extends to other tissues and body fluids and also may turn the urine dark. Yellowing of only the skin also can be caused by eating too many carrots or drinking too much carrot juice.
The bile pigment, bilirubin, comes from red blood cells. When old red blood cells are destroyed by the body (a normal process), the oxygen-carrying molecule within the cells, hemoglobin, is released into the blood. The hemoglobin is rapidly converted to bilirubin in the blood. The bilirubin is removed from the blood by the liver, modified, and excreted into the bile.